Diagnostic Utility of Fine Needle Aspiration Cytology in the Evaluation of Peripheral Lymphadenopathy

BACKGROUND

Patients are often referred for fine needle aspiration cytology (FNAC) on account of peripheral lymphadenopathy. Relative to the rate of referrals, very few works have been done to establish the reliability of FNAC as a first-line investigation in the evaluation of peripheral lymphadenopathy in this environment. This study aims to determine the diagnostic utility of FNAC in evaluating common causes of peripheral lymphadenopathy in a teaching hospital in North western Nigeria.

STUDY DESIGN

Eighty-six patients who had FNAC and histology or cell blocks preparation of the same lymph nodes were recruited over a 5-year period. Using histology and cell blocks as gold standards, the sensitivity, specificity, predictive values and test accuracy were deduced.

RESULTS

The sensitivity, specificity, positive and negative predictive values were 71.4%, 91.5%, 87.5% and 81.1% respectively. The test accuracy of FNAC was 83.7%.

CONCLUSION

FNAC is reliable for screening and diagnosing peripheral lymph node lesions. However, ancillary tests such as immunocytochemistry may be necessary for improved accuracy.

Changing patterns of Kaposi's sarcoma in Nigerians

This is a five-year retrospective study of 32 histologically diagnosed cases of Kaposi's sarcoma (KS) who had undergone HIV antibody testing at the Jos University Teaching Hospital: 13 cases (40%) were HIV-negative. Multiple lesions were more common in HIV-positive cases and affected unusual sites such as the face, oropharynx, conjuctiva, vulva and rectum in addition to the limbs and trunk, which were more frequently involved in HIV-negative cases. This pattern of KS seen in Nigerian patients shows similarities with other African countries which have been affected by the HIV epidemic.

Ruptured Tubal Gestation: An Unusual Presentation of Schistosoma Haematobium Infection of the Fallopian Tube

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.

Histological pattern of thyroid gland neoplasms in Kano, Northern Nigeria

BACKGROUND AND OBJECTIVE

Thyroid gland neoplasms occur globally with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. There is, however, no published histological study from northwestern Nigeria; hence, the need for this retrospective study to document the pattern in Kano.

MATERIALS AND METHOD

This was a retrospective study of all histologically diagnosed thyroid neoplasms in the Department of Pathology, Aminu Kano Teaching Hospital (AKTH), Kano Nigeria, over a ten year period from 1st January, 2002 to 31st December, 2011.

RESULTS

A total of 522 thyroid specimens (1.5% of all biopsies) were received over the ten year period. Thyroid neoplasms accounted for 157 (30.1%) of all the thyroid specimens, comprising 130 females (82.8%) and 27 males (17.2%) with female to male ratio of 4.8:1. The ages range from 15 to 80 years with a mean age of 35.8 years and peak occurrence in the 4th decade. There were 82 cases (52.2%) of thyroid adenoma (mostly follicular) while thyroid carcinoma accounted for 66 cases (42%). Papillary carcinoma predominated (53%) followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). One case each (1.5%) of anaplastic carcinoma, squamous cell carcinoma and metastatic squamous cell carcinoma were seen. All the malignant tumours were epithelial and all except one were primary thyroid malignancy.

CONCLUSION

Thyroid neoplasmis a common thyroid gland lesion in Kano with a striking female preponderance. Thyroid adenoma was the most common benign neoplasm while papillary carcinoma seen a decade earlier in females was the most common malignant thyroid neoplasm. The predominance of papillary carcinoma over follicular carcinoma is a reverse of the finding of an earlier clinicopatholgical study on thyroid gland diseases in Kano.

Verrucous (hypertrophic) cutaneous lupus erythematosus: a case report

Verrucous (Hypertrophic) lupus erythematosus (LE) represents a rare but distinct, variant of chronic discoid lupus erythematosus. We report a case of LE with verrucous lesions for its rarity and peculiar location posing a diagnostic dilemma.

Seasonal trends in epidemiological and entomological profiles of malaria transmission in North Central Nigeria

The influence of seasonal changes on epidemiological and entomological indices of malaria transmission in North Central Nigeria was elucidated in a series of studies carried out between January 2004 and December 2009. The climate in the study area was divided into three seasonal periods namely, rainy (May-October), dry (December-March) and transitional (April and November), during which larval and adult anopheline mosquito collections were carried out and assessed for densities, sporozoite infection and parity rates and potentials for malaria transmission. The results indicated that the climate in the study area was clearly seasonal, with close similarities in the patterns of distribution of the climatic factors in the study sites. Mosquito densities, both at the adult and larval stages (i.e., 29.35 +/- 5.10 adult mosquitoes/man/night and 10.36 +/- 3.34 larvae/dip, respectively), were significantly (p<0.05) highest during the rainy season. However, while the former varied significantly in the three seasonal periods, the latter was not significantly different during the dry and transitional seasons. Malaria transmission risks, in terms of sporozoite rates and entomological inoculation rates, was significantly (p<0.05) least in the dry season (i.e., 2.89 +/- 1.25% and 0.37 +/- 0.21 infective bite/man/night, respectively) but the two variables were not significantly (p>0.05) different during the transitional and rainy seasons. Adult mosquito daily survival rate and adult longevity were least in the dry season (26.52 +/- 11.80% and 6.80 days, respectively) and significantly (p<0.05) highest during the rainy season (72.28 +/- 4.00% and 16.95 +/- 4.20 days, respectively). Parous rates of the mosquitoes and duration of sporogony had distinct distribution pattern from the other variables investigated. While, significantly highest parous rates were recorded in the transitional season (86.00 +/- 4.30%), duration of sporogony was not significantly (p>0.05) different during the three seasons. The epidemiology of urban malaria in North Central Nigeria was discussed from the view points of the these results and concluded that the findings should promote the development of informed temporally-targeted vector control programs for the area.

Idiopathic scrotal calcinosis; a rare scrotal tumour: a case report and review of literature

Idiopathic scrotal calcinosis is a rare benign disease characterized by multiple, asymptomatic and painless nodules on the scrotum. We herein report this rare disease in a Nigerian adult male and briefly review the relevant literature.

Immunohistochemical study of epithelial-myofibroblast interaction in Barrett metaplasia

CONTEXT

Sub-epithelial myofibroblasts are known to influence the biology (proliferation, differentiation and apoptosis) of overlying epithelia. In the intestine, myofibroblasts have been demonstrated to be essential for epithelial differentiation. It is therefore hypothesized that myofibroblasts may also be involved in intestinal metaplasia that is characteristic of Barrett esophagus.

OBJECTIVE

This study endeavors to immunohistologically evaluate epithelial-myofibroblast interaction in Barrett's metaplasia.

MATERIALS AND METHODS

Nineteen archival esophageal endoscopic biopsies of Barrett's metaplasia were immune-phenotyped for the following epithelial and myofibroblast antigens - cytokeratins (CK) 8, 13, 18, CDX2 (Caudal type homeobox 2), a-smooth muscle actin (SMA).

RESULTS

alpha-SMA immunostaining revealed close association between myofibroblasts and metaplastic Barrett's epithelium but not with normal esophageal squamous epithelium. Myofibroblasts were more prominent in dysplastic than in non-dysplastic Barrett metaplasia. CDX2 and CK 8/18, indicators of intestinal differentiation were expressed in Barrett metaplasia but not normal esophageal squamous epithelium, while the reverse was the case for CK 13, which only stained normal esophageal squamous epithelium.

CONCLUSION

Although their precise role is yet to be clearly defined, sub-epithelial myofibroblasts are very likely involved in the pathogenesis of Barrett's metaplasia.

Thyroid cancers in nodular goiters in Kano, Nigeria

BACKGROUND

Cancer is an occasional incidental finding in nodular goiter, but there has been no formal study on this disease in our locality.

AIMS AND OBJECTIVES

To determine the occurrence of histologically diagnosed malignancy in patients who present with nodular goiters.

METHODOLOGY

This is a 7-year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters at Aminu Kano Teaching Hospital, Kano.

RESULTS

There were 160 multinodular goiters during the study period, out of which 24 (15.0%) had histologically diagnosed cancer, and 1 out of the thirteen patients with solitary thyroid nodule (7.6%) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years, with a mean age of 38.8 years. Eighteen (72%) were females, and 7 (28%) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13 (52%) cases, followed by papillary in 10 (40%), medullary carcinoma in 1 (4%) and anaplastic carcinoma in 1 (4%) patient.

CONCLUSION

One-seventh of nodular goiters in our center harboured malignancy, and follicular carcinoma was the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspiration would improve preoperative diagnosis and guide appropriate surgical management.

Ichthyosis hystrix Curth-Macklin type in an African girl

Ichthyosis hystrix Curth-Macklin type is a rare autosomal dominant skin disorder characterized by extensive hyperkeratosis and palmo-plantar keratoderma. It results from heterozygous frameshift mutation in keratin 1 gene (KRT1). Histological features, showing perinuclear vacuolization and binucleated cells, are similar to those of epidermolytic hyperkeratosis except for the absence of epidermolysis. The present report describes the condition in a 16-year-old African girl where available treatment was disappointing.

Type 2 segmental Darier's disease in a twelve-year-old Nigerian male--a case report

Darier's disease is an autosomal dominant disorder characterized clinically by presence of keratotic papules in a seborrheic distribution, nail involvement and mucosal lesions. There are several clinical variants of Darier's disease, but few cases of segmental Darier's disease have been described in the literature. We describe a 12-year-old boy with type 2 mosaic phenotype. This unique clinical variant of Darier's disease has been described very rarely.

Krukenberg's tumour

BACKGROUND

Krukenburg's tumour, a metastatic cancer to the ovary can pose difficulties in early diagnosis. The paucity of reports from our environment coupled with the difficulties we encountered makes it imperative that we report this case.

METHODS

We present a 32-year-old lady who presented with mucoid and bloody diarrhoea associated with menstrual irregularity, weight loss and lower abdominal pains 2 years after surgical treatment for gastric cancer. Literature on Krukenburg's tumour was also reviewed.

RESULTS

While serum level of CEA was found to be elevated and colonoscopy showed an ulcerated mass obliterating the lumen of the sigmoid colon, abdominal CT scan revealed bilateral adnexal masses. The histology of the colonic lesion showed signet ring carcinoma while the enlarged ovaries turned out to have evidence of metastatic adenocarcinoma.

CONCLUSION

Early diagnosis of KT can be difficult. Periodic surveillance is, therefore, essential especially in those who have had a gastrointestinal malignancy.

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.

Dyschromatosis universalis hereditaria in a young Nigerian female

Dyschromatosis universalis hereditaria (DUH) is a clinically heterogeneous disorder that shows generalized mottled pigmentation. It occurs most commonly in Japanese persons, with sporadic reports from South Africa, India, and Iraq. Histopathology reveals a variable degree of pigmentary incontinence. Although the precise etiology of this disorder is not yet known, the clinicopathological findings implicate an inherent abnormality of melanosomes or melanin processing. We describe a case in a young Nigerian girl.

Implementing a hospital based injury surveillance system in Africa: lessons learned

A multinational injury surveillance pilot project was carried out in five African countries in the first half of 2007 (Democratic Republic of the Congo, Kenya, Nigeria, Uganda and Zambia). Hospitals were selected in each country and a uniform methodology was applied in all sites, including an injury surveillance questionnaire designed by a joint programme of the Pan American Health Organization and the United States Centres for Disease Control and Prevention. A total of 4207 injury cases were registered in all hospitals. More than half of all injury cases were due to road traffic accidents (58.3%) and 40% were due to interpersonal violence. Self-inflicted injuries were minimal (1.2% of all cases). This report provides an assessment of the implementation of the project and a preliminary comparison between the five African countries on the context in which inter-personal injury cases occurred. Strengths and weaknesses of the project as well as opportunities and threats identified by medical personnel are summarized and discussed. A call is made to transform this pilot project into a sustainable public health strategy.

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

Background

Benign prostatic hyperplasia (BPH) is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above.

Transurethral prostatectomy (TURP) is the ultimate treatment of choice for benign prostatic hyperplasia (BPH) due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions.

Methods

The records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved.

Results

Five Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients), bladder neck stenosis (16 patients) or bladder tumour around the trigon (2 patients). The age range of the patients was 47–110 years with a mean of 67.2 years. 289 patients (80.1%) had urethral catheter in situ at presentation and 11 (3%) patients had suprapubic cystostomy of which only 3 (0.85%) had combined urethral stricture and BPH.

Only 131 (26%) had their PSA measured which ranged from 2–100 ng/ml out of which 39(29.8% n = 131) patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131) patient had a PSA level of 4 ng/ml and malignant prostate.

Hospital stay was 1–32 days (mean 7.9) and the mean follow up period was 5.6 months (range 0–60) and there were 17.5% complications comprising of urinary tract infection (UTI) 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC) 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615.00 (range US$ 300–1,300)

Conclusion

Despite advances in minimally invasive therapy for LUTH/BPH, TURP is the optimum treatment of choice for the ageing male of sub-Saharan Africa. It is however not available to the majority of patients in this region due to poor health allocation and inadequate facilities and training.

Cancer in Nigeria: a 10-year analysis of the Kano cancer registry

BACKGROUND

Cancer is a major health problem in developed countries and epidemiological evidence shows the emergence of a similar tend in developing countries, particularly in sub-Saharan Africa where HIV/AIDS is predicted to augment the cancer burden. The present study analyses the profile of cancers recorded in the first decade (1995-2004) of establishment of the Kano cancer registry (KCR) a histology/cytology-based registry in Kano, Nigeria.

METHODS

Records of cancer cases diagnosed based on histology or cytology and entered into the registry were retrieved and categorized by type/organ sites affected according to International Classification of Diseases for Oncology

RESULTS

There was a steady rise in frequency of cancer over the period where a total of 1990 cancer cases were recorded comprising of 1001 (50.3%) males and 989 (49.7%) females. Cancers of the cervix (22.9%), Breast (18.9%), Ovary (8.2%), non-melanoma skin cancer (6.3%), and Uterus (6.2%) were the most frequent female cancers. In males, cancer of the prostate (16.5%), bladder (10.2%), non-melanoma skin (9.9%), colorectum (9.3%) and connective tissue (6.3%) were most common. Burkitt's lymphoma (31.4%), other lymphoreticular cancers (23.8%) and retinoblastoma (20%) predominated in children.

CONCLUSION

The KCR supports existing predictions of an increase in incidence of cancers in developing countries. There is need for establishment of comprehensive cancer control programmes in developing countries for the common cancers of the cervix, breast, prostate, bladder, skin and colorectum which are amenable to prevention, early detection and cure.

Implementing a hospital based injury surveillance system: a case study in Nigeria

A pilot study of violent injury surveillance was implemented in two hospitals in Kano, Nigeria, in two phases: a formative evaluation including training and arranging the collection of hospital information, followed by a 6 month prospective data collection. Road traffic injuries constituted about 80 per cent of the cases, gunshot injuries were the commonest in victims of interpersonal violence (IPV). The causes and context of IPV, the relationship of victims and perpetrators, and the place, related activities and anatomical site of injuries from IPV are summarized.

Pathology of peripheral lymph node biopsies in Kane, Northern Nigeria

BACKGROUND

Lymphadenopathy is a common clinical problem here in Kano, Northern Nigeria but there has been no formal study. We therefore undertook this review to evaluate the pattern in our locality.

METHOD

This is a seven-year (1998-2004) retrospective review of all histologically diagnosed lymph node biopsies received at Aminu Kano Teaching Hospital, Kano.

RESULTS

Cervical, axillary and inguinal nodes were the most frequently biopsied accounting for 46%, 23% and 13%, while tuberculosis, lymphomas and metastases were the most commonly diagnosed lesions comprising 30%, 24% and 19% respectively. In general, benign lesions were more common constituting 57% of nodal biopsies. Lymphadenopathy was observed to be most prevalent in the first three decades.

CONCLUSION

Our findings were broadly similar to most other Nigerian studies and slightly at variance with other African countries but significantly different from the Western World. The limitations of lymph node histopathology in the absence of modern molecular diagnostic techniques are highlighted.

Giant and complicated subcutaneous lipoma of the neck

BACKGROUND

Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare.

OBJECTIVE

To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision.

CASE REPORT

A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up.

CONCLUSION

Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria

BACKGROUND

The pattern of morbidity and mortality reflects the burden of disease in a particular community. This pattern shows geographic variations between communities and countries. The knowledge of the pattern of diseases and their contribution to mortality in a given country is very important in evaluating its health care delivery system. Such knowledge is important for health planning and for improving the healthcare services in that particular nation. We set out to study the mortality pattern in our medical wards.

MATERIALS AND METHODS

This is a retrospective study that reviewed the causes of death in the medical wards of Aminu Kano Teaching Hospital (AKTH) Kano between January 2001 and December 2003 (three years). The data were obtained from the admission and discharge/death register, patients' case records, the weekly as well as quarterly mortality reviews. The SPSS version 10 was used to analyse the data.

RESULTS

A total of 3369 patients were admitted over the 3 year study period. Of these 2518 (74.7%) were discharged or referred and 851 patients died, giving an overall mortality rate of 25.3%. The male to female admission ratio was 1.6:1. Majority of deaths, 714 (83.9%) occurred after 24 hours of admission. The most important causes of death were infectious diseases other than HIV/AIDS (17.9%), cerebrovascular disease (17%), HIV/AIDS (13.6%), chronic renal failure (12.5%) and diseases of the circulatory system (11.9%).

CONCLUSION

Mortality in the medical wards reflects the emerging trend of mixed disease spectrum burden comprising communicable and non communicable diseases. Public health education, raising the socio-economic status of our people as well as improving the standards of our health care facilities and personnel would prevent a large proportion of deaths from medical wards.

Effect of environmental iodine deficiency (EID) on foetal growth in Nigeria

BACKGROUND & OBJECTIVES

There is scarcity of information on impact of iodine deficiency on growth and development of newborns, both pre-term and term babies. The present study was carried out to see the impact of iodine deficiency (ID) on the intrauterine foetal growth and development in terms of birth weight (BW) in an African population living in an iodine deficient zone.

METHODS

The maternal and cord serum thyroid parameters at term delivery (38-40 wk of gestation) were measured and correlated with the birth weights of the corresponding newborns, and the results compared between those assessed in an ID zone (Jengere region of Bassa district, Plateau State, Nigeria) and with that of non ID (Control) zone, Jos, the State capital.

RESULTS

The level of maternal and neonatal thyroid function were significantly reduced in the group with low birth weights (<2.5 kg) as compared to the level seen in normal birth weights category in both control (Jos) and ID (Jengere) regions. Both in non ID and ID regions the maternal serum thyroxine (T4), thyroxine binding globulin (TBG) and free thyroxine index (FT4I) were positively correlated (P<0.005) with BW of term babies while thyroid stimulating hormone (TSH) (P<0.005) and thyroxine binding capacity (TBK) (P<0.05) showed negative correlation. Maternal T3 and T3/T4 ratio did not show any correlation with BW in Jos, while in the ID region of Bassa the BW showed a positive correlation (P<0.005) with the maternal serum T3 and T3/T4 ratio. Cord serum analysis of the term babies revealed that the BW was positively correlated with its T4, triiodothyronine (T3), TBG, FT4I and T4/TBG ratio (Jos only) (P<0.005) in both ID region of Bassa and non ID control zone of Jos. Cord serum TSH and TBK showed negative correlation (P<0.005) with BW. Thyrotrophin releasing hormone (TRH) stimulation test revealed that mothers with small for date (SFD) babies at term were more hypothyroid compared to the level of thyroid function seen in the women delivering normal babies.

INTERPRETATION & CONCLUSION

Maternal thyroid hormone plays a significant role in the intrauterine foetal growth and development, and the smaller babies and their corresponding mothers, in an ID affected area are functionally sub-thyroid in greater proportion due to prevailing long standing environmental iodine deficiency (EID). Maternal T3 is an important factor in the defence of foetus in ID regions.

Hormonal abnormalities in azoospermic men in Kano, Northern Nigeria

BACKGROUND & OBJECTIVES

We undertook this study to observe the pattern of hormonal abnormalities and testicular pathology in azoospermic male Africans in Kano, Northern Nigeria.

METHODS

Eighty consecutive azoospermic infertile males attending fertility clinic in Aminu Kano Teaching Hospital, Kano, were selected for the study. Their semen were analyzed three times at eight weeks interval, after which serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin were assayed in serum samples, and histological examination of testicular biopsies done.

RESULTS

Of the 80 subjects studied, 32 (40%) had abnormal hormonal levels, 48 (60%) had normal hormonal values and 36 (45%) had testicular pathology.

INTERPRETATION & CONCLUSION

Endocrinopathies are common in azoospermia. Their contribution to male factor infertility cannot be overemphasized. The main reason for the endocrinopathies is not known but environmental factors, endocrine disruptors and genetic polymorphism have been suggested to be contributory.

Post transplant Kaposi's sarcoma among Nigerians: a report of two cases

With the establishment of kidney transplant centres in Nigeria and increase in the number of kidney transplant recipients returning home for follow up after successful transplant abroad, an increasing number of patients with post transplant complications are likely to be seen. There is the need for physicians vested with the care of these patients to be aware of the post transplant complications so that early diagnosis and effective treatment can be instituted so as to save both the patient and the allograft. Two out of seventeen renal transplant recipients followed up in our unit had post renal transplant Kaposi's sarcoma. Both were successfully treated with withdrawal of cyclosporin, reduction of other immunosuppressives and introduction of low dose Mycophenolate Mofetil (MMF). One had a course of radiotherapy followed by weekly intravenous vincristine and the other only had vincristine with complete remission of the lesions in both patients. Post transplant Kaposi's sarcoma occurs in Nigerian transplant patients and this report highlights the need for increased awareness and high index of suspicion of post transplant Kaposi's sarcoma among kidney transplant recipients.

Characteristics of colorectal carcinoma in Kano, Nigeria: an analysis of 50 cases

BACKGROUND

Several recent publications have shown a rising incidence with high morbidity and mortality of colorectal cancer amongst blacks. The aim of this study was to determine the epidemiological profile of the colorectal carcinoma in our hospital, a major referral centre in northwestern Nigeria.

METHODOLOGY

A retrospective analysis of all histologically proven cases of colorectal carcinoma was performed from January 1999 to December 2002.

RESULTS

Fifty patients were managed during the study period with an average presentation of 12.5 cases per year. There were 36 (72%) males and 14 (28%) females (M:F = 2.5 to 1). The mean age at presentation was 42.9 years with 36 patients (72%) below 50 years of age. Carcinoma of the colon occurred in 22 (44%) patients and rectal carcinoma in 28 (56%) patients. Twenty (71.4%) of the 28 rectal cancers were digitally palpable. Thirty-eight (92.7%) patients had palliative resection, while 3 (7.3%) had curative resection. Adenocarcinoma was the only histologic type, with 15 (30%) cases of the mucinous variety.

CONCLUSION

There is need to increase awareness through public education about this malignancy and its management. Any adult with complaints of vague abdominal pain, blood or mucus in the stool or features of haemorrhoids which may herald the onset of colorectal cancer should be adequately investigated with digital rectal examination (DRE) and proctosigmoidoscopy and barium enema where appropriate.

Glomus tumour--the report of a case in an adult Nigerian

BACKGROUND

Glomus tumour, a relatively common lesion in Caucasians is reported to be rare in blacks.

METHOD

A case of glomus tumour is reported in an adult male Nigerian to highlight its distinctive clinical presentation and the literature reviewed.

RESULT

A 60-year old man presented with a painful skin nodule on the ventral surface of his right forearm. The pain was far in excess of the size of the lesion. There was however no relief from previous medications. Following complete excision of the lesion, pain relief was dramatic. Histopathological examination of the lesion showed sheets of round to polyhedral glomus cells and elongated endothelium lined vascular channels diagnostic of glomus tumour.

CONCLUSION

Severe pain is a very important feature of glomus tumour of the skin. This is relieved by complete excision of the lesion.

Intraoperative colonic lavage in emergency surgical treatment of left-sided large bowel lesions

There has been a trend towards resection and primary anastomosis after on-table lavage in patients with left sided colonic emergencies. This study will analyse the outcome in our centre. Thirty-two patients underwent the operation for various lesions of the left colon and the rectum between December 1998 and December 2002. The mean age of the patients was 37.7+/-11.1 years. Mean extra time for the procedure was 37.4+/-5.2 min. The mean hospital stay was 11.2+/-2.9 days. Postoperative complications included four cases (12.5%) of wound infection, and one (3.1%) right sub-phrenic abscess. No clinical anastomotic leakage or mortality was recorded. This study shows that primary anastomosis with on-table colonic lavage can be a safe procedure in selected, low risk patients.

Neonatal chemical hypothyroidism in Nigeria

To investigate the level of neonatal chemical hypothyroidism (NCH), thyroid function was measured in the cord blood of 271 neonates in an area with a high prevalence of endemic goitre, Bassa (n = 140), and a nonendemic area, Jos (n = 131), in Plateau State, Nigeria. NCH was defined as T4 < 40 nmol/L and TSH > 49 mU/L and borderline compensated NCH as T4 31-50 nmol/L and TSH 41-49 mU/L. NCH was detected in 16.4% of neonates in Bassa and in 3.8% in Jos. Borderline compensated NCH was detected in an additional 18.6% in Bassa and 8.4% in Jos. Contamination of foodstuffs and water by iodine-containing antiseptics and disinfectants during the antenatal period, in addition to factors responsible for endemic goitre, e.g. iodine deficiency and goitrogens, are considered to be responsible for the high prevalence of NCH in the Bassa area. As most infants' thyroid function recovers with time, the former might be a more important factor in the aetiology of NCH.

Typhoid enteric perforation in north western Nigeria

BACKGROUND

Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality.

AIMS AND OBJECTIVES

To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano.

METHOD

A retrospective Analysis of patients treated for typhoid perforation over a 6-year period.

RESULTS

There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis.

CONCLUSION

Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Thyroid gland diseases in Kano

Goiter is endemic in some parts of Nigeria. Kano is populated by people from various geographical areas. There has not been any report of thyroid gland diseases pattern in Kano, hence the need for this study. A retrospective review of 75 cases of thyroid gland diseases seen and managed at Aminu Kano Teaching hospital, Kano over a 5-year period forms the basis for this study. Of the 75 patients with goiters 69(92% ) were females. Simple non-toxic goiter was the most common histologic type accounting for 51 (68.0% ) of cases. There were 10 cases (13.3% ) of thyrotoxicosis, 4 (5.4% )with follicular adenoma, and 10 (13.3% ) other patients had proven carcinoma. Well-differentiated follicular carcinoma was the most common malignant type, 7 of which were not recognised as such preoperatively. All cases were treated by surgery with minimal morbidity and mortality. Thyroid surgery constitutes a significant proportion of surgical practice in Nigeria. While increase in dietary iodine will reduce the incidence of goiter everywhere, the impact of iodinisation of salt is yet to be determined. A population based survey of the prevalence of thyroid gland disease in Kano northwest, Nigeria is strongly indicated.

Bladder cancer in Kano--a histopathological review

Malignant tumours of the bladder have been observed to be quite common in Kano but there has been no formal study. This four-year (1998-2001) retrospective review sought to document the pattern of these neoplasms. Vesical malignancies constituted 6.4% of all cancers in Kano with squamous (53%) and transitional (35%) carcinomas as the most common histological types. Males outnumbered females more than five times (M:F = 5.2.:1). Cancer of the bladder was most prevalent in the 5th and 6th decades with a mean age of 48.8 years. In general our findings are similar to bladder cancer in other schistosomal endemic regions of Africa.

Early detection of prostate cancer: evaluating the diagnostic performance of prostate specific antigen by comparing with histological technique among africans

This study was conducted to investigate the diagnostic performance characteristics of prostate specific antigen (PSA) by comparing serum PSA value with histological findings in patients suspevted of having prostate cancer in Aminu Kano Teaching Hospital. Nigeria. Clinical and Laboratory records were examined and collated for serum PSA values, together with histological findings of biopsy specimen, clinical diagnosis, age of patients, and mode of presentation. The serum PSA values were determined by ELECSYS 1010 autoanalysers Roche, Germany based on electrochemiluminescence immunoassay technique. The results show that serum PSA values increase with age in the assymptomatic non-cancer patients who came for medical check up but were within normal limit. In prostatic disease conditions PSA values were raised in benign prostatic hyperplasia 35.957± 4.0315ng/ml, in undifferentiated carcinoma 56.22±4.295ng/ml and adenocarcinoma >100ng/ml as compared to the normal range (0-4ng/ml). These cases were confirmed by histological diagnosis. It is concluded that PSA evaluations is a sensitive marker for prostate cancer but because of various other conditions that affect serum PSA concentration, other methods of investigations such as Digital Rectal examination, Trans Urethral Ultra-Sonography and histological examination should be combined to confirm diagnosis. Prognosis of patients will be better if early diagnosis is made.

Intussusception in Kano: a 5-year analysis of pattern, morbidity and mortality

BACKGROUND

Intussusception is a common surgical problem in childhood. This study was undertaken to determine the clinico-pathologic pattern of the disease in Kano.

METHODS

Thirty-two cases of intussusception were retrospectively studied over a 5-year.

RESULTS

Twenty-nine (90.6%) occurred in children and 3 (9.4%) in adults. Of the 29 childhood cases, 20 (68.9%) were males and 9 (31.1%) were females, with a male to female ratio of 2.2 to 1. Infantile intussusception constituted 21 (72.4%), while 8 (27.6%) were between 2 to 8 years of age. Ileocolic intussusception was the most common type with 16 cases (55.2%), while the others accounted for 13 (44.8%). All the childhood cases were idiopathic as there was no underlying cause. In contrast, adult intussusception was usually secondary to an underlying aetiological factor, with the colocolic type more common in 2 (66.7%), and ileocolic in 1 (33.3%). Surgery was the main treatment modality with a high resection rate, and a mortality of 9.4% mainly in patients with intestinal gangrene and septicaemia.

CONCLUSION

Early presentation and prompt treatment is the key to reducing morbidity and mortality.

Histopathologic diagnoses of lymphadenopathy in children in Jos, Nigeria

Histopatholgical findings in 242 lymph node biopsies received in Jos University Teaching Hospital over a 10-year period (1988-1997) were reviewed. Tuberculosis is the most predominant lesion (33.05%), followed closely by the non-Hodgkin's lymphoma (31.4%). Burkitt's lymphoma accounting for one-quarter of all the cases of non-Hodgkin's lymphoma had a peak age range of 8-10 years. Hodgkin's lymphoma, chronic non-specific lymphadenitis, sinus histiocytosis, reactive hyperplasia, metastatic carcinoma, dermatopathic lymphadenitis, Kaposis sarcoma and sarcoidosis accounted for 2.9%, 14.46%, 9.9%, 4.96%, 1.7%, 0.4%, 0.8% and 0.4% respectively. The cervical region was the commonest site affected (54.1%), followed by mesenteric (22.3%), axillary (13.2%) and inguinal (10.3%). BCG immunization was carried out only on 121(50%) of cases, out of which 60 had tuberculosis and 54(22.3%) received no BCG immunization, while 67(27.7%) had no records of BCG immunization. Only 5(2%) had HIV screening done, out of which one was positive.

A review of medico-legal deaths in Kano

Medicolegal death (MLD) is a relatively uncommon subject of study in Nigeria. This prospective review of 200 cases in Kano found the commonest cause to be road traffic accidents (48.5%) followed by homicides (34%) and natural deaths (5%). Gang violence among local youths with blunt and sharp weapons accounted for most of the homicides. MLDs most frequently (60.5%) occurred in the 3rd to 5th decades of life and males were predominant (M:F = 3.5:1). Our findings differed significantly from MLDs in the developed world where natural deaths were overwhelmingly preponderant. The prevalence of MLDs in Kano can be substantially reduced if the recommendations of this study are implemented.

A review of 101 homicide cases in Jos, Nigeria

A five-year retrospective analysis of 101 homicide cases in Jos, Nigeria was carried out between 1995 and 1999. Of the total number, 47 were killed with sharp cutting or piercing instruments, 28 with firearms and 21 died from physical assaults. Five of the victims sustained fatal burn injuries. Majority of the cases (62.4%) were aged between 21 and 40 years and males outnumbered females by a ratio of 7.4:1. It is concluded that although a significant proportion of homicides are not premeditated, communal violence and robbery attacks remain the most frequent precipitating events that result in homicide in this environment.

Histopathological review of prostatic diseases in Kano, Nigeria

Diseases of the prostate are common causes of morbidity in adult males and show wide geographical and ethnic variations in incidence and mortality worldwide. It is in the light of this that records of prostatic biopsies were reviewed in retrospect at the Aminu Kano Teaching Hospital, Kano and Murtala Mohammed Hospital Kano over a 4-year period in order to determine the histological pattern and age distribution of the various prostatic lesions. Three hundred and three prostatic lesions constituting 7.4% of all surgical biopsy specimens received were studied. Two hundred and thirty five (77.6%) of these were cases of BPH while prostatic cancer accounted for 22.4% of cases. The ratio of benign to malignant prostatic disease was 3:5:1. Chronic non-specific prostatitis, acute prostatitis, schistosomiasis and tuberculosis were present in 22.8%, 3.3%, 0.7% of the total number of cases respectively. The mean age of BPH patients was 63.7 years, and 88% of them had a glandulostromal histological pattern. Majority (64.2%) of the prostate cancers were well-differentiated adenocarcinoma and the mean age was 67.1 years. The findings confirm earlier observations that prostatic diseases are common causes of morbidity in our environment, and early diagnosis and treatment remain key measures in reducing mortality. The practice of 5-region biopsy is advocated to improve detection of clinical prostate cancer.

Perforin-independent CD8(+) T-cell-mediated cytotoxicity of alveolar epithelial cells is preferentially mediated by tumor necrosis factor-alpha: relative insensitivity to Fas ligand

CD8(+) T cells appear to play an important pathophysiologic role in many inflammatory lung diseases. The primary effector function of this T-cell subset is cytolysis of virus-infected cells, and it is widely believed that there are two primary molecular mechanisms by which this occurs: the perforin/granzyme-mediated pathway of cytolysis, and the Fas ligand (FasL)-Fas (CD95/APO-1) pathway of induction of target-cell apoptosis. This conclusion is based primarily on data obtained with hematopoetic cell lines as target cells. There is also a growing body of evidence that Fas is involved in the transduction of apoptotic signals in a variety of inflammatory disease states, particularly involving the liver and the lung. In the study reported here we took advantage of a novel in vitro assay to directly assess the effector mechanisms employed in CD8(+) T-cell-mediated cytolysis of alveolar epithelial cells. We present evidence that FasL-induced, Fas-mediated apoptosis does not directly contribute to T-cell-mediated cytolysis of alveolar epithelial-derived cells, even though Fas is expressed and functional on these cells. We also demonstrated that the perforin-independent cytolytic activity of CD8(+) T cells against alveolar epithelial-derived cells is explained entirely by tumor necrosis factor-alpha (TNF-alpha), which is expressed on CD8(+) T cells. Furthermore, we show that bystander cytolysis of alveolar epithelial-derived cells by antiviral CD8(+) T cells is entirely perforin-independent. This activity is mediated exclusively by TNF-alpha. Both alveolar epithelial-derived cells and primary murine type II cells show susceptibility to apoptosis triggered by soluble TNF-alpha, without the need for transcriptional or translational inhibition. We also confirmed the resistance of alveolar type II cells to FasL in vivo by performing adoptive transfer of perforin-deficient antiviral CD8(+) T cells into transgenic mice expressing a target antigen in type II epithelial cells. Significant lung injury developed in the transgenic CD8(+) T-cell recipients, whether or not Fas was expressed in these animals. Furthermore, preincubation of the T cells with antibody to TNF-alpha completely abolished the injury. These results suggest that alveolar epithelial cells are relatively sensitive to T cell-triggered, TNF-alpha-mediated apoptosis, and resistant to apoptosis triggered by FasL. These observations may have important ramifications for understanding of the pathophysiology of interstitial and inflammatory lung diseases.

Structural and functional consequences of alveolar cell recognition by CD8(+) T lymphocytes in experimental lung disease

CD8(+) T cells infiltrate the lung in many clinical conditions, particularly in interstitial lung disease. The role(s) that CD8(+) T cells might be playing in the pathogenesis of inflammatory lung disease is unclear at present, as is the direct contribution of CD8(+) T cell effector activities to lung injury. This report describes a transgenic model used to evaluate the impact, on respiratory structure and function, of CD8(+) T lymphocyte recognition of a target antigen expressed endogenously in alveolar epithelial cells. We found that adoptive transfer of cloned CD8(+) cytotoxic T lymphocytes (CTLs) specific for an alveolar neo-antigen (influenza hemagglutinin) leads to progressive lethal injury in transgenic mice, which dramatically affects lung structure and function. Transgenic recipients of CD8(+) CTLs exhibited tachypnea and progressive weight loss, becoming moribund over a period of several days. Concomitantly, the animals developed a progressive interstitial pneumonitis characterized initially by lymphocytic infiltration of alveolar walls and spaces, followed by an exuberant mononuclear cell infiltration that correlated with restrictive pulmonary mechanics and a progressive diffusion impairment. These results indicate that antigen-specific CD8(+) T cell recognition of an alveolar epithelial "autoantigen" is, in and of itself, sufficient to trigger an inflammatory cascade that results in the histological and physiological manifestations of interstitial pneumonia.